Provider Demographics
NPI:1003947284
Name:SONRISAS RADIANTES DENTAL CLINIC(CSP)
Entity Type:Organization
Organization Name:SONRISAS RADIANTES DENTAL CLINIC(CSP)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAGALY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-883-6446
Mailing Address - Street 1:CENTRO GRAN CARIBE SUITE 214
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-6711
Mailing Address - Country:US
Mailing Address - Phone:787-883-6446
Mailing Address - Fax:787-883-6058
Practice Address - Street 1:CENTRO GRAN CARIBE SUITE 209
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-6711
Practice Address - Country:US
Practice Address - Phone:787-883-6446
Practice Address - Fax:787-883-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental